The diagnosis of liver diseases induced by hepatitis B virus (HBV) is supported by the detection of HBV surface antigen (HBsAg) in serum. The present study aimed to investigate the presence of HBV deoxyribonucleic acid (DNA) in patients with liver cirrhosis using a polymerase chain reaction (PCR) based on primers derived from the pre-S1 and pre-core regions. HBsAg was detected in 10 of 48 patients (21%), total anti-hepatitis B core antigen (HBc) antibodies in 54%, anti-hepatitis B e antigen (HBeAg) in 14.6%, anti-HBc immunoglobulin M in 8%, and anti-HBs in 26%; none had detectable HBeAg. HBV DNA was detected in 73% of the cirrhotic patients. All cirrhotic patients with HBsAg also had HBV DNA; HBV DNA was detected in 64.5% of those without HBsAg. We conclude that the clearance of HBsAg does not necessarily indicate termination of viraemia in patients with liver cirrhosis and the detection of HBV DNA using a PCR based on primers from the pre-S1 and pre-core regions should be included in the diagnosis of HBV infection.

Aged↗

PubMedDate not supplied

[Primary spontaneous pneumothorax. A retrospective study of 495 cases].

We conducted a retrospective study of patients treated in our department for primary spontaneous pneumothorax (PSP) between 1986 and 1993. The 495 patients were between 12 and 81 years old (mean 28.2 years). Four hundred fifteen (83.8%) were men and 80 (16.2%) were women. PSP was in the right lung in 262 cases (52.9%) and in the left lung in 215 (43.5%). Both sides were affected in 18 cases (3.6%). The initial treatment was pleural drainage; small caliber drains were used in 85 and no associated complications were observed. On 185 occasions (37.3%), patients required surgical repair as a result of air leaks, recurrence or acute hemorrhage. There were postsurgical complications in 15 cases (8.1%) but no recurrences or deaths after surgery. We observed no significant differences in the number of recurrences after use of conventional drains or small caliber drains. Nor were there differences in mean time of hospital stay or complications after conventional surgery or video assisted surgery, a technique that has only recently been introduced. We conclude that PSP responds well to treatment with pleural drains and that small caliber catheters offer a good alternative for treating first episodes. Surgery is indicated when there is recurrence or when air leaks are persistent. At present, video assisted thoracoscopic surgery has successfully replaced axillary thoracotomy for most patients.

Adolescent↗

PubMedDate not supplied

Multiple myeloma: an overview of diagnosis and management.

BACKGROUND: Multiple myeloma, a lethal disease resulting from proliferation of immunoglobulin-secreting cells, accounts for approximately 1% of malignant neoplasms in the United States and affects blacks twice as often as whites. OBJECTIVE: To review the historic, epidemiologic, diagnostic, and therapeutic features of multiple myeloma. SUMMARY: Multiple myeloma is often diagnosed when a monoclonal protein is found in the serum or urine or both. No single test differentiates benign from malignant plasma cell proliferation. The clinical features of multiple myeloma develop from tissue damage secondary to the monoclonal gammopathy, plasma cells, and cytokines excreted by the cells. Increased vulnerability to infection is due to depressed normal immunoglobulins. The melphalan-and-prednisone regimen improves median survival from 7 months to 3 years in the 50% to 60% of patients who respond. Cure is exceedingly rare. Refractory and resistant multiple myeloma patients should be treated on investigational protocols. CONCLUSIONS: There has been substantial advancement in our understanding of the biology of multiple myeloma and related plasma cell neoplasms over the past two decades. We can reasonably hope that improvements in treatment will ensue.

Antineoplastic Combined Chemotherapy Protocols↗

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Laparoscopic colorectal resections. Initial experience at the AUB-MC.

BACKGROUND: Laparoscopic colorectal surgery has many advantages to offer. However, it is a complex procedure, and demands advanced technical skills and instrumentation. In addition, its safety when applied to malignant disease is debatable. In this article, we present the early experience and short term results of laparoscopic colorectal resections performed at the American University of Beirut Medical Center. PATIENTS AND METHODS: Between March 1997 and August 1998, 14 patients with various colorectal lesions underwent attempt at laparoscopic colorectal resection, at the American University of Beirut Medical Center. Seven patients were males (50%) and 7 were females (50%); their mean age was 59 yrs (range 40-73 yrs). Ten patients (72%) had malignant disease and 4 patients (28%) had benign disease. RESULTS: The operation was completed in 13 out of 14 patients (93%). The overall mean operative time was 176 min (range 135-270 min). The operation was taking less time as surgeons gained experience. The average hospital stay was 7.6 days (range 4-11 days). The last four patients, however, stayed less than six days in the hospital. There were no mortalities. There were three complications (21%), two patients had wound infection, and one patient had a prolonged ileus. All were managed conservatively. Ten patients had malignant disease. In these patients, the operative margins were clear of disease. The average number of lymph nodes retrieved was 10.4 (range 3-19). These patients were followed up for an average period of 7.4 months (range 1-16 months). There was one recurrence. There was no port site metastasis in any patient. CONCLUSION: Laparoscopic colorectal surgery is feasible and safe. The preliminary results are encouraging. Its application in malignant disease still awaits the results of prospective studies.

Adult↗

PubMedDate not supplied

Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase III, double-blind, comparative trial.

PURPOSE: Zoledronic acid, a new and more potent bisphosphonate, was compared with pamidronate, the current standard treatment for patients with osteolytic or mixed bone metastases/lesions. PATIENTS AND METHODS: A total of 1,648 patients with either Durie-Salmon stage III multiple myeloma or advanced breast cancer and at least one bone lesion were randomly assigned to treatment with either 4 or 8 mg of zoledronic acid via 15-minute intravenous infusion or 90 mg of pamidronate via 2-hour intravenous infusion every 3 to 4 weeks for 12 months. The primary efficacy endpoint was the proportion of patients experiencing at least one skeletal-related event over 13 months. RESULTS: The proportion of patients with at least one skeletal-related event was similar in all treatment groups. Median time to the first skeletal-related eventwas approximately 1 year in each treatment group. The skeletal morbidity rate was slightly lower in patients treated with zoledronic acid than in those treated with pamidronate, and zoledronic acid (4 mg) significantly decreased the incidence and event rate for radiation therapy to bone, both overall and in breast cancer patients receiving hormonal therapy. Pain scores decreased in all treatment groups in the presence of stable or decreased analgesic use. Zoledronic acid (4 mg) and pamidronate were equally well tolerated; the most common adverse events were bone pain, nausea, fatigue, and fever and < 5% of serious adverse events were related to the study drug. The incidence of renal impairment among patients treated with 4 mg of zoledronic acid via 15-minute infusion was similar to that among patients treated with pamidronate. CONCLUSIONS: Zoledronic acid (4 mg) via 15-minute intravenous infusion was as effective and well tolerated as 90 mg of pamidronate in the treatment of osteolytic and mixed bone metastases/lesions in patients with advanced breast cancer or multiple myeloma. (Can-

Antineoplastic Agents↗

PubMedDate not supplied

Evaluation of erythropoiesis in protein energy malnutrition.

This study evaluated erythropoiesis in 50 infants hospitalized with protein energy malnutrition and in 50 control infants. The red cell count, mean corpuscular haemoglobin and reticulocyte index were significantly lower, while the white blood cell count, median corpuscular fragility and red cell distribution width were significantly higher on admission than in controls. Total serum protein, albumin, fasting blood glucose, and serum folate were significantly lower on admission than in controls. Serum ferritin was significantly higher and total iron-binding capacity was significantly lower on discharge compared to controls. The serum erythropoietin was significantly higher on admission and discharge than in controls. The anaemia of protein energy malnutrition is due to mixed deficiencies resulting in ineffective erythropoiesis despite an increased level of erythropoietin.

Anemia↗

PubMedDate not supplied

Fertile life span of rabbit spermatozoa in the presence of an intrauterine contraceptive device.

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Animals↗